Private Organization Accreditation

Heartland for Children is the not-for-profit agency responsible for the foster care system in Polk, Highlands, and Hardee Counties.


Audrey Coleman, RN-MSN

Volunteer Roles: Military Reviewer; Peer Reviewer; Team Leader

My first experience with COA was in 1999 with what was a NC Area Program. I started as a peer reviewer in 2005, doing two to four site visits a year. I am also a team leader and have recently been approved to be a military reviewer.
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Residential Treatment Services provide individualized therapeutic interventions and a range of services, including education for residents to increase productive and pro-social behavior, improve functioning and well-being, and return to a stable living arrangement in the community.

RTX 4: Assessment

Residents and their families participate in a comprehensive, individualized, trauma-informed, strengths-based, and culturally and linguistically competent assessment process that informs and guides service delivery, discharge planning, and aftercare services.

Interpretation: Assessments should be child, youth, adult, and/or family-focused, as appropriate to the needs and wishes of the resident, the service population, or program type. 

Interpretation: When the organization is working with an Indian family, tribal representatives or other tribal community members must be involved in the assessment process, as determined by the tribe and the family.

Interpretation: The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA’s Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design.

Note: Organizations should review state Medicaid plans or other third party reimbursement requirements to ensure they are meeting required timeframes for conducting assessments.

Research Note: For an assessment to be trauma-informed, it assumes that every individual has likely been exposed to experiences that are traumatic, including abuse (physical, psychological or sexual), neglect, out-of-home placements, or persistent stress. Adopting this assumption in all levels of treatment ensures the organization actively avoids instances that traumatize the resident.  

Research Note: All children, youth, and families have areas of strength and resilience. Staff should engage residents and their families in an open and safe dialogue about their strengths, struggles, fears, and experiences during the assessment process to ensure that residents and their families are the focus of treatment efforts. Comprehensive assessment that guides effective service planning will be best achieved when families are engaged as partners in identifying their strengths and needs. 

Rating Indicators
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g.,  
  • Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Culturally responsive assessments are the norm and any issues with individual staff members are being addressed through performance evaluations (HR 6.02) and training (TS 2.05); or
  • Active client participation occurs to a considerable extent; or
  • Diagnostic tests are consistently and appropriately used, but interviews with staff indicate a need for more training (TS 2.08).
Practice requires significant improvement, as noted in the ratings for the Practice standards.  Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Assessment and reassessment timeframes are often missed; or
  • Assessment are sometimes not sufficiently individualized;
  • Culturally responsive assessments are not the norm and this is not being addressed in supervision or training; or
  • Staff are not competent to administer diagnostic tests , or tests are not being used when clinically indicated; or
  • Client participation is inconsistent; or
  • Assessments are done by referral source and no documentation and/or summary of required information present in case record; or
  • One of the Fundamental Practice Standards received a rating of 3 or 4.
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g.,
  • There are no written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing; or  
  • Two or more Fundamental Practice Standards received a rating of 3 or 4.

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    • Assessment and reassessment procedures, including strategies for family engagement
    • Interdisciplinary assessment tools and/or criteria included in the assessment
    • Data on timeliness of assessments
    • Interview:
      1. Program director
      2. Relevant personnel
      3. Residents
    • Review case records

  • RTX 4.01

    The information gathered for assessments is strengths-based, comprehensive, directed at concerns identified in the initial screening, and limited to material pertinent for meeting service requests and objectives.

  • RTX 4.02

    Residents actively participate in a timely, individualized interdisciplinary assessment of:
    1. family, environmental, cultural, and religious or spiritual factors;
    2. educational and vocational accomplishments;
    3. social skills, hobbies, and recreational activities and interests; and
    4. strengths, skills, and special interests.

    Interpretation: Assessments are completed within timeframes established by the organization and are updated periodically. 

    Interpretation: Standardized and evidence-based assessment tools are recommended to inform decision-making in a structured and consistent manner.

  • FP
    RTX 4.03

    Clinical personnel conduct a bio-psychosocial evaluation with the participation of a licensed psychiatrist, psychologist, or other qualified mental health professional, or review a recent evaluation that includes:
    1. a psychiatric history;
    2. a mental status examination;
    3. a trauma assessment, when appropriate;
    4. intelligence and projective tests, as necessary; and
    5. a behavioral appraisal.

    Interpretation: Personnel that conduct evaluations should be aware of the indicators of a potential trafficking victim, including, but not limited to:

    1. evidence of mental, physical, or sexual abuse; physical exhaustion;
    2. working long hours;
    3. living with employer or many people in confined area;
    4. unclear family relationships;
    5. heightened sense of fear or distrust of authority;
    6. presence of older significant other or pimp;
    7. loyalty or positive feelings towards an abuser;
    8. inability or fear of making eye contact;
    9. chronic running away or homelessness;
    10. possession of excess amounts of cash or hotel keys; and
    11. inability to provide a local address or information about parents. 
    ?Several tools are available to help identify a potential victim of trafficking and determine next steps toward an appropriate course of treatment. Examples of these tools include, but are not limited to, the Rapid Screening Tool for Child Trafficking and the Comprehensive Screening and Safety Tool for Child Trafficking.
    Interpretation: Other mental health professionals can include: psychiatric nurse practitioners, licensed social workers, or professionals with specialized training and skills in the nature and treatment of mental illness. 

    Interpretation: The organization should have mechanisms in place for sharing information among service providers that respects confidentiality and encourages continuity of care and treatment.

    Research Note: A trauma screen refers to a brief measure or tool that determines whether an individual has experienced specific traumatic events. Trauma screening tools usually detect exposure to potentially traumatic events or experiences or the presence of traumatic stress symptoms and reactions. 

    If there is an indication of trauma during the trauma screen then the individual should also receive a comprehensive, evidence-based trauma assessment. The trauma assessment is a diagnostic process that is conducted by a clinician or trained mental health professional and determines whether clinical symptoms of traumatic stress are present as well as the severity of symptoms that impact the individual’s level of functioning and treatment options. 

    Personnel with specialized trauma-related education, skills, and training, or a qualified cooperating service provider, screen and assess individuals for trauma symptoms.

  • RTX 4.04

    Assessments consider factors related to successful group living including:
    1. possible reciprocal individual and group effects;
    2. the individual’s ability to adjust to a group; 
    3. previous placements; and 
    4. trauma history.

    Interpretation: Safety issues may arise when placing individuals, with little or no notice, into a residential living environment prior to completion of a full assessment. The organization must ensure the smoothest transition possible for both new and current residents.

  • RTX 4.05

    Assessments are conducted in a culturally and linguistically competent manner and identify resources that can increase service participation and support the achievement of agreed upon goals.

    Interpretation: Culturally and linguistically competent assessments can include attention to geographic location, language of choice, and the person’s religious, spiritual, racial, ethnic, and cultural background. Other important factors that contribute to a responsive assessment include attention to age, sexual orientation, gender identity, and developmental level.

  • FP
    RTX 4.06

    When a resident’s initial screening indicates a substance use condition, the organization:
    1. records a thorough alcohol and drug use history, including an evaluation of the effects of alcohol and other drug use on the resident’s family;
    2. arranges for an appropriate level of care and detoxification, as necessary; and
    3. provides referrals to the resident and/or family members, as appropriate, when the program does not serve individuals with substance use conditions.

  • FP
    RTX 4.07

    The organization assesses and treats or refers identified victims and perpetrators of abuse and neglect.

    Interpretation: The organization complies with mandatory reporting laws and only releases information with the written, informed consent of the person or legal guardian.

    Research Note: The William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 requires federal, state, and local officials who discover a minor who may be a victim of human trafficking to notify the U.S. Department of Health and Human Services within 24 hours to facilitate the provision of interim assistance.

  • RTX 4.08

    Reassessments are conducted as needed, including at specific milestones in the treatment process such as:
    1. after significant treatment progress;
    2. after a lack of significant treatment progress;
    3. after new symptoms are identified;
    4. when significant behavioral changes are observed; 
    5. when there are changes to a family situation or parental status; 
    6. when significant environmental changes occur; or 
    7. when a resident returns following an episode of running away.

    Interpretation: Reassessments are completed within timeframes established by the organization depending on the population served. 
    Interpretation: Organizations should have protocols that address runaway episodes to welcome and reintegrate children back into the program, as well as respond to children’s physical and clinical needs. 

    Note: For residents that return after an episode of running away, refer to RTX 9.01 for guidance on timeframes for medical screens.  

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